Pain, opioids and naloxone

A drug overdose rescue kit at a training session on how to administer naloxone, which reverses the effects of heroin and prescription painkillers, in Buffalo, N.Y., in 2015. (Carolyn Thompson/AP)

The March 10 editorial “Another painful truth about opioids” cited a Veterans Affairs study showing that opioids are not effective for managing long-term back pain as evidence that “the opioid epidemic’s roots lie in a wave of permissive prescribing of opioids that turns out . . . to have been unjustified even as good pain management practice.”

Such a broad inference was challenged by Anne Fuqua’s March 11 Outlook essay, “Which is the bigger crisis: Addiction or pain?” Ms. Fuqua, a former nurse who was diagnosed with a severe neurological disorder that responded only to opioids, saw her doctor increasingly frightened by the anti-opioid campaign to the point that he left pain management altogether. It was extremely hard for her to find another doctor willing to prescribe opioids for her pain. She keeps track of reports of pain sufferers who have killed themselves because they were not able to tolerate their pain, now more than 100: “Just a few years ago, discussion of suicide was rare in the community of pain patients. Now I see it on online bulletin boards, in article comments and in online groups dedicated to the subject.”

Perhaps there are two crises: addiction and pain. Trading fewer addicts for more pain patients or trading fewer pain patients for more addicts are false choices. We should advocate solutions that address both crises.

Naloxone saves lives, but it does not treat addiction. On its own, it cannot prevent overdoses or addiction-related crime, nor can it resolve the opioid epidemic. The problem highlighted by the working paper Ms. McArdle mentioned is not that naloxone encourages people suffering from addiction to take risks; it is the lack of good treatment options available to individuals with opioid addiction. Medication- ­assisted treatment is lifesaving for opioid addiction, yet few receive it following an overdose. Most are simply released upon revival and medical stabilization.

Pervasive stigma against addiction is responsible for the lack of available treatment. As a society, we continually fail to treat addiction as we treat other diseases. Naloxone is akin to a defibrillator, which can restart a patient’s heart but won’t cure underlying heart disease. It is difficult to imagine that defibrillators would be described as a moral hazard for individuals who do not make lifestyle changes to reduce their risk of heart disease.

We must stop searching for a “silver bullet” to address this crisis and recognize that a comprehensive approach is needed. If we don’t provide effective treatment to individuals who suffer an overdose, we are not using naloxone to its full potential.

Lindsey Vuolo, New York

The writer is associate director of health law and policy at the National Center on Addiction and Substance Abuse.

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